Abstract
This randomized three-armed controlled clinical trial compared the effect of titanium tetrafluoride (TiF4) and sodium fluoride (NaF) varnishes on caries control in smooth surfaces of permanent dentition and children's acceptability. Sixty children (6-8 y/o) were randomly divided into TiF4 (2.45% F-), NaF (2.26% F-) or placebo (control) groups. Varnishes were applied on permanent teeth once a week for the first 4 weeks and after the 6th and 12th months of the study. The variables were as follows: International Caries Detection and Assessment System (ICDAS) scores, quantitative fluorescence changes, visual plaque index (VPI) and degree of acceptability. Two-way RM-ANOVA, ANOVA/Tukey and χ2 tests were performed (p < 0.05). No differences were found between the treatments with respect to ICDAS scores (p = 0.32). Only TiF4 reduced the mean fluorescence loss significantly at 18 months compared to the baseline (p = 0.003). TiF4 showed a lower percentage of new caries lesions by tooth surface than the placebo, while NaF did not induce such a change (p < 0.014). Regardless of the treatment, more than 95% of the participants reported being satisfied. For all groups, the VPI decreased significantly at 3 months compared to the baseline value (p < 0.001), with no differences between the treatments (p = 0.17). TiF4 had a similar ability to control caries lesions as NaF; however, only TiF4 differed from the placebo (p = 0.004). The acceptability of TiF4 varnish was similar to that of NaF varnish.
Highlights
The protective effect of titanium tetrafluoride (TiF4) on dental caries has been intensively investigated using in vitro and in situ models.[1,2,3,4,5,6] Comar et al.[3] demonstrated a significant effect of TiF4 varnish in the remineralization of initial enamel caries lesions in situ, regardless of caries activity, while NaF was able to remineralize enamel lesions under low cariogenic challenges only
The mechanism of action of NaF varnish is based on calcium fluoride (CaF2) deposition on the dental surface, which acts as a fluoride reservoir interacting with tooth hydroxyapatite and as a mechanical barrier against acids.[7,8]
TiF4 varnish induces a higher deposition of CaF2 on enamel due to its low pH than that induced by NaF varnish.[8]
Summary
The protective effect of titanium tetrafluoride (TiF4) on dental caries has been intensively investigated using in vitro and in situ models.[1,2,3,4,5,6] Comar et al.[3] demonstrated a significant effect of TiF4 varnish in the remineralization of initial enamel caries lesions in situ, regardless of caries activity, while NaF was able to remineralize enamel lesions under low cariogenic challenges only. The mechanism of action of NaF varnish is based on calcium fluoride (CaF2) deposition on the dental surface, which acts as a fluoride reservoir interacting with tooth hydroxyapatite and as a mechanical barrier against acids.[7,8] On the other hand, TiF4 has an additional effect due to the presence of titanium that reacts with apatite-forming compounds such as hydrated titanium phosphate and titanium dioxide, responsible for the highly. Acid-resistant layer precipitated on teeth, improving the mechanical barrier.[8] TiF4 varnish induces a higher deposition of CaF2 on enamel due to its low pH than that induced by NaF varnish.[8]
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